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What A1c Is Too High For Surgery

A1c Is A Predictor Of Clinical Outcomes Following Noncardiac Surgery

A1c Is A Predictor Of Clinical Outcomes Following Noncardiac Surgery

Researchers discover that preoperative A1C is related to length of stay in the hospital following noncardiac surgeries…. Acute hyperglycemia at the time of surgery is associated with poor clinical outcomes in all patients. Furthermore, diagnosis of diabetes mellitus is known to be a risk factor for complications postoperatively. Some healthcare practitioners use insulin infusion protocols to provide better glycemic control and prevent hyperglycemia during and after surgery to help lower the risk of complications. Less is known about the effect of chronic hyperglycemia on surgical outcomes postoperatively, and whether addressing this issue prior to surgery would improve outcomes. A study was therefore designed to evaluate whether A1C impacts outcomes following surgery independent of any hyperglycemia that may occur perioperatively. Data for this study was obtained from the National Surgical Quality Improvement Program database and from the data registry of the Brigham and Women’s Hospital. Data for patients having noncardiac surgery from 2005-2010 and requiring admission to the hospital for ≥1 day following surgery were included in this study. The 622 patients were divided into four groups based on their A1C levels. The groups were as follows: A1C≤6.5%, A1C 6.5-8%, A1C.8-10%, and A1C >10%. Patients were compared to nondiabetic control subjects of the same age, sex, and BMI. The results of the data obtained showed patients with A1C 6.5-8% had a hospital LOS similar to the matched group of nondiabetic patients. Patients with an A1C≤6.5% or >8% had a hospital LOS that was significantly longer when compared to that of the matching nondiabetic patients. It may seem surprising that A1C≤6.5% was also associated with increased hospital LOS. It is thought that this co Continue reading >>

Surgery Cancelled..again...a1c Levels Still Too High

Surgery Cancelled..again...a1c Levels Still Too High

Surgery cancelled..again...A1C levels still too high I am sorry that I do not know what A1C levels are:(I feel sorry for you but remember everything happens for a reason and you will have your surgery soon. Sending good thoughts and prayers to you. KEEP YOUR CHIN UP!I ALSO AM DIABETIC SO I KNOW THE STRUGGLESWITH A1C LEVELS. JUST DO EVERYTHING IN YOURPOWER, TAKE MEDS, STAY AWAY FROM SUGAR ANDTHE LEVELS SHOULD COME DOWN.JUST KEEP THINKING POSITIVE THOUGHTS, STAY DILIGENTAND SOON YOU WILL BE JOINING US ON THE LOSERSBENCH.KEEP SMILINGTHERESE Oh I'm so sorry your surgery was cancelled. Did the doctor tell you what your A1C levels should be? I was ( I guess I am still am but my A1c was 5.2 last checked) a type 2 diabetic and before surgery my A1C levels were 7.5. My WLS surgeon never told me to watch my numbers or surgery would be cancelled. Are you on insulin or something to bring your numbers down? When will they check you again and what numbers are they looking for?Don't give up!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Hang in there hon. highest 239/Day of surgery 225/Current 119 TT and Breast Lift 3/08 awwww hun I hate to hear that. Wish I could let u borrow my A1C level long enough to get u through. After it bein a bit higher my pcp added an extra med and I started wat*****arbs more close. I got it back down to 6.5 now.And YES being diabetic Justa lil note to warn all pre and post ops. GET YOUR PROTEIN IN EVERYDAY!!! I have done rather crappy with mine since day 1 and I am paying dearly with VERY slow weight loss, major hair loss, and all out feelin like shit! PLEASE!!!! Follow your program's rules!! Continue reading >>

Delaying Joint Replacement Surgery Until Hemoglobin A1c Is Less Than 7%

Delaying Joint Replacement Surgery Until Hemoglobin A1c Is Less Than 7%

Delaying Joint Replacement Surgery Until Hemoglobin A1c is Less Than 7% Allan S. Brett, MD reviewing Giori NJ et al. J Bone Joint Surg Am 2014 Mar 19 The benefit of this practice, which delays or prevents surgery for some diabetic patients, is unclear. Increasingly, orthopedists are insisting that diabetic patients lower their glycosylated hemoglobin (HbA1c) levels to less than 7% before they undergo total joint arthroplasty. But this is far easier said than done, particularly in older patients, in whom tight control increases risk for potentially dangerous hypoglycemia. A study from the orthopedic clinic at a U.S. Veterans Affairs hospital illustrates this problem. During a 5-year period, 59 diabetic patients who were deemed otherwise suitable for total hip or knee arthroplasty were not scheduled for surgery because their HbA1c levels were >7%. The patients were referred back to their primary care physicians to intensify glycemic control. After an average of 8 months, 35 (59%) achieved HbA1c levels 7%, but the remaining 24 patients (41%) were unable to do so. Only 5 of those 24 patients ultimately had surgery. Reluctance to perform total hip or knee arthroplasty on diabetic patients with HbA1c levels >7% is based on assumptions that this threshold is a good predictor of risk for postoperative complications (especially deep infection) and that preoperative lowering of HbA1c reduces that risk. But observational studies do not uniformly support the first assumption ( NEJM JW Gen Med Mar 28 2013 ), and no randomized trials have tested the second one. Indeed, it might be that glycemic control immediately after surgery is more important for preventing complications than control during the months before surgery. EDITOR DISCLOSURES AT TIME OF PUBLICATION Disclosures for Allan Continue reading >>

Preoperative Glycemic Control For Adult Patients With Diabetes Undergoing Elective Surgery

Preoperative Glycemic Control For Adult Patients With Diabetes Undergoing Elective Surgery

Tristan B. Weir, BS, Florida State University College of Medicine, Larry C. Deeb, MD, Florida State University College of Medicine As the prevalence of diabetes continues to increase in the United States, a higher proportion of elective surgical candidates will require specific preoperative education and guidelines to maximize patient outcomes and reduce the costs of care. The purpose of this article is to review the current literature to determine how preoperative glycemic control affects the lengths of hospital stays, postoperative complications, and mortality in people living with type 1 and 2 diabetes. Additional recommendations are provided for preoperative hypo- and hyperglycemia, the use of insulin pumps or continuous glucose monitors, and day-of-surgery management of insulin and oral hypoglycemic agents. Gaps in medical evidence are acknowledged and future directions in research are proposed to provide high-quality guidelines for the preoperative care of adult patients with diabetes. Introduction As the prevalence of diabetes increases in the United States, practicing physicians must be able to educate and manage these patients in the preoperative setting. With 29.1 million (9.3% of the U.S. population) Americans living with diabetes today, nearly 1 in 10 surgical candidates may have diabetes and require special recommendations before surgery [1]. While the 2011 Joint British Diabetes Societies Inpatient Care Group (JBDS) created guidelines for the preoperative management of patients with diabetes undergoing elective surgery, many physicians in the U.S. may not know these guidelines exist [2]. In a 2014 study on preoperative hemoglobin A1C (A1C) and its effect on clinical outcomes for patients undergoing surgery, the authors say “there are no standards of care Continue reading >>

If Your A1c Is Too High?

If Your A1c Is Too High?

Do they delay your surgery? Ys, every surgeon is different, etc., but did anyone experience this? in my case, i know my levels weren't great day of WLS but having high blood sugar/diabetes/insulin is one of the main health reasons many sleevers get WLS shortly after surgery - most peoples situations improve in my case - awhile after WLS, all my meds/insulin were gradually taken away good thoughts you won't have prob with doc - and your diabetes will also improve/go away!!!! I would really doubt that they would delay it. You might be on a more restrictive pre-op to get down as much weight as possible. The A1C is a composite of weeks/months of glucose levels. So you current glucose level would be a more determining factor of your surgery risk. My A1C was 7.0 at the time of my surgery it is now 5.5. They did check my glucose about ever 4 hours when I was in the hospital and it was pretty high like 285, but it came down over time and now runs in the 85-90 range. Do they delay your surgery? Ys, every surgeon is different, etc., but did anyone experience this? Super high blood sugars day of surgery, maybe. High A1C, doubtful. The A1C is just an average for the last 3 months. If you hit the OR with a 400 blood sugar, there is a serious risk of ketoacidosis. You don't want to start at 400 and then have your surgery cause it to climb 600+. I saw a significant spike in blood sugar post op for a few weeks. I have Kaiser and in order to have the surgery, they wanted my A1c done to 5.99. Well, it wasn't down but with some diet changes, my A1C did drop some and I had the surgery. It is normal for our blood sugar to spike after the trauma of surgery and that was the first time I've ever had insulin injections. After day 3, no more insulin was needed and my blood sugar was normal. Yay Continue reading >>

Voice Of The Diabetic

Voice Of The Diabetic

A Wake-Up Call From the Editor: Marilyn Brandt Smith lives in Louisville, Kentucky, with her husband Roger and their son Jay. The Smiths are retired teachers, and Marilyn is also a freelance writer and editor. My husband's talking watch announced that it was 6:00 p.m. when the phone rang. Thanks to his audio caller ID, he knew instantly who was calling that April evening. But the doctor's office should have been closed. Did surgeons work this late? "You have to get your blood glucose down, or we aren't doing your surgery next week," said the voice on the other end of the line. My fifty-six-year-old husband Roger had been suffering from infections, headaches, congestion, and pain, and, when he went to the doctor to investigate the cause, they found a tooth fragment lodged in his sinus cavity, the result of a routine tooth extraction last summer. Since Roger was diagnosed with type 2 diabetes at age forty-eight, he had been managing with oral medication, improved diet, and increased exercise. He lost fifty pounds, and, although his A1C has crept up in recent years, he thought he was in reasonably good control. Then the surgeon called to report a blood glucose level of 270 mg/dl, more than double what a fasting glucose should be. Something had to change and fast. Diabetes runs in Roger's family, and he has always known he might someday need to go on insulin. Although Splenda and other sugar-free goodies appear regularly on our grocery list, his diet is not as good as it should be. He was, and still is, a great fan of the all-you-can-eat buffet. The morning after that disappointing phone call, we went to see our family doctor, and Roger got an A1C test. The result left everyone speechless: His A1C was 9.3 percent--far too high. Our doctor knew that Roger would prefer to avo Continue reading >>

Ultimate Guide To The A1c Test: Everything You Need To Know

Ultimate Guide To The A1c Test: Everything You Need To Know

The A1C is a blood test that gives us an estimated average of what your blood sugar has been over the past 2-3 months. The A1c goes by several different names, such aswa Hemoglobin A1C, HbA1C, Hb1C, A1C, glycated hemoglobin, glycohemoglobin and estimated glucose average. What is Hemoglobin? Hemoglobin is a protein in your blood cells that carries oxygen. When sugar is in the blood, and it hangs around for a while, it starts to attach to the red blood cells. The A1C test is a measurement of how many red blood cells have sugar attached. So, if your A1C result is 7%, that means that 7% of your red blood cells have sugar attached to them. What are the Symptoms of a High A1C Test Level? Sometimes there are NO symptoms! That is probably one of the scariest things about diabetes, your sugar can be high for a while and you may not even know it. When your blood sugar goes high and stays high for longer periods of time you may notice the following: tired, low energy, particularly after meals feel very thirsty you may be peeing more than normal, waking a lot in the middle of the night to go dry, itchy skin unexplained weight loss crave sugar, hungrier than normal blurred vision, may feel like you need new glasses tingling in feet or hands cuts or sores take a long time to heal or don’t heal well at all frequent infections (urinary tract, yeast infections, etc.) When your blood sugar is high, this means the energy that you are giving your body isn’t getting into the cells. Think about a car that has a gas leak. You put gas in, but if the gas can’t get to the engine, the car will not go. When you eat, some of the food is broken down into sugar and goes into your bloodstream. If your body can’t get the sugar to the cells, then your body can’t “go.” Some of the sugar tha Continue reading >>

Can I Have Cataract Surgery If My Blood Sugar Is Too High Or Too Low?

Can I Have Cataract Surgery If My Blood Sugar Is Too High Or Too Low?

Question: I hear that before cataract surgery I must have my blood sugar tested because cataracts are believed to be associated with diabetes. Is that true and what happens if indeed my sugar level is high or low--can a surgery be done all the same? Answer: Yes, the cataract surgery can be performed if you have diabetes. And yes, diabetes is associated with an increased incidence of cataracts. But it is important to know if you have diabetes so that it can be well controlled before surgery. Continue reading >>

"a!c Level Before Surgery": Diabetes Community - Support Group

The risk of infection and poor healing is very high with your glucose levels out of control. I can understand why a surgeon would want your A1C to be in a safe range before performing surgery. Follow my journey at www.mch-breastcancer.blogspot.com I've had lots of surgeries and no one ever tested my A1C as part of my pre-op work-up I had back surgery when my blood glucose was way too high and it took forever to heal. I was in an emergency situation and it was determined that the risk was higher to not have the surgery than to have the surgery. Five months later I had another back surgery and my A1c had dropped from 11.9 to mid 7's, my healing time was much quicker. The bottom line is that the better your A1c is and the better your overall health is the lower the risk for complications is and the opportunity for better outcome is higher. I do not know what "requirements" each doc has for surgery but I would be looking for a good discussion with your doctor to understand specifically what he is looking for and why. It also may be time for another opinion. I am not a Dr or nurse but I can say I have T-2 (in remission) and have been through a partially torn rotator cuff surgery. I did not have an A1c done before surgery, I did have the normal blood tests which included the glucose readings. But then my A1c has never been over 6.2. Perhaps that is why they did not do the A1c. I can see the need for your A1c to be within the normal range prior to surgery because it is a healing aid. We as diabetics do not heal well to begin with and a high A1c will only prolong the healing process. Not only that if your A1c is not in the 5 to 7 range now it could get worse after the surgery due to stress, pain and medications. It is typical to have complete rotator cuff tears surgery repairs Continue reading >>

High Preoperative Hemoglobin A1c Is A Risk Factor For Surgical Site Infection After Posterior Thoracic And Lumbar Spinal Instrumentation Surgery.

High Preoperative Hemoglobin A1c Is A Risk Factor For Surgical Site Infection After Posterior Thoracic And Lumbar Spinal Instrumentation Surgery.

High preoperative hemoglobin A1c is a risk factor for surgical site infection after posterior thoracic and lumbar spinal instrumentation surgery. Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, Japan. J Orthop Sci. 2014 Mar;19(2):223-8. doi: 10.1007/s00776-013-0518-7. Epub 2013 Dec 25. BACKGROUND: Diabetes mellitus (DM) is reported to be a risk factor for surgical site infection (SSI), which is a serious complication after spinal surgery. The effect of DM on SSI after instrumented spinal surgery remains to be clarified. The aim was to elucidate perioperative risk factors for infection at the surgical site after posterior thoracic and lumbar spinal arthrodesis with instrumentation in patients with DM. METHODS: Consecutive patients who underwent posterior instrumented thoracic and lumbar spinal arthrodesis during the years 2005-2011, who could be followed for at least 1 year after surgery, were included. These included 36 patients with DM (19 males and 17 females; mean age 64.3 years). The patients' medical records were retrospectively reviewed to determine the SSI rate. The characteristics of the DM patients were examined in detail, including the levels of serum glucose and HbA1c, which indicate the level of diabetes control. RESULTS: Patients with DM had a higher rate of SSI (6 of 36 patients, 16.7 %) than patients without DM (10 of 309 patients, 3.2 %). Although the perioperative serum glucose level did not differ between DM patients that did or did not develop SSI, the preoperative HbA1c value was significantly higher in the patients who developed SSI (7.6 %) than in those who did not (6.9 %). SSI developed in 0.0 % of the patients with controlled diabetes (HbA1c <7.0 %) and in 35.3 % of the patients with unco Continue reading >>

Diabetes And Its Negative Impact On Outcomes In Orthopaedic Surgery

Diabetes And Its Negative Impact On Outcomes In Orthopaedic Surgery

Go to: PATHOPHYSIOLOGY Diabetes mellitus can be broadly classified into three types, based on the onset of symptoms and the absolute need for insulin replacement. Patients who have an absolute requirement for insulin, secondary to autoimmune dysfunction of the pancreatic beta cells, have type 1 DM. The vast majority of patients have type 2 DM which is associated with older patients, elevated body mass index (BMI), genetic predisposition, history of DM during pregnancy, less active individuals, and certain ethnic groups. Four out five patients with type 2 DM have an elevated BMI. Children and adolescents, particularly from certain ethnic and racial groups (African - American, Mexican American, and Pacific Islander), are being diagnosed with type 2 DM at an increasing rate. During the early stages of type 2 DM the pancreas usually produces insulin, however insulin resistance is present and glucose metabolism is negatively impacted. A small percentage of pregnant women develop gestational DM and 40% to 60% of these patients will ultimately develop type 2 DM within 5 to 10 years. The end result of DM, regardless of the etiology, is hyperglycemia. The primary energy source for our body is glucose, and glucose is stored as glycogen in the liver and skeletal muscle. Insulin facilitates glucose uptake into the peripheral cells, assisting with the storage of glycogen. While patients with type 1 DM have an absolute need for insulin replacement, patients with type 2 DM initially produce insulin, sometimes in high amounts. The problem is so called “insulin resistance”, in which the cells become less sensitive to insulin and hyperglycemia results. Stress hyperglycemia can occur in hospitalized patients without a previous history of DM and is defined as any serum glucose > 140 mg Continue reading >>

Preoperative A1c And Clinical Outcomes In Patients With Diabetes Undergoing Major Noncardiac Surgical Procedures

Preoperative A1c And Clinical Outcomes In Patients With Diabetes Undergoing Major Noncardiac Surgical Procedures

OBJECTIVE To evaluate the relationship between preoperative A1C and clinical outcomes in individuals with diabetes mellitus undergoing noncardiac surgery. RESEARCH DESIGN AND METHODS Data were obtained from the National Surgical Quality Improvement Program database and the Research Patient Data Registry of the Brigham and Women’s Hospital. Patients admitted to the hospital for ≥1 day after undergoing noncardiac surgery from 2005 to 2010 were included in the study. RESULTS Of 1,775 patients with diabetes, 622 patients (35%) had an A1C value available within 3 months before surgery. After excluding same-day surgeries, patients with diabetes were divided into four groups (A1C ≤6.5% [N = 109]; >6.5–8% [N = 202]; >8–10% [N = 91]; >10% [N = 47]) and compared with age-, sex-, and BMI-matched nondiabetic control subjects (N = 888). Individuals with A1C values between 6.5 and 8% had a hospital length of stay (LOS) similar to the matched control group (P = 0.5). However, in individuals with A1C values ≤6.5 or >8%, the hospital LOS was significantly longer compared with the control group (P < 0.05). Multivariate regression analysis demonstrated that a higher A1C value was associated with increased hospital LOS after adjustments for age, sex, BMI, race, type of surgery, Charlson Comordity Index, smoking status, and glucose level on the day of surgery (P = 0.02). There were too few events to meaningfully evaluate for death, infections, or readmission rate. CONCLUSIONS Our study suggests that chronic hyperglycemia (A1C >8%) is associated with poor surgical outcomes (longer hospital LOS). Providing a preoperative intervention to improve glycemic control in individuals with A1C values >8% may improve surgical outcomes, but prospective studies are needed. Diabetes mellitus i Continue reading >>

A1c Too High For Surgery?

A1c Too High For Surgery?

This is my first time posting. I am still working on the requirements that the insurance company requires and hope to submit for approval in June to have surgery (RNY) this summer. I'm diabetic and I went to a nutritionist this past week and she told me that no surgeon would operate on me with my A1C as high as it currently is (8.7). Has anyone had their surgery postponed or canceled due to their blood sugar being too high? I'm going to work hard on getting my A1C down before the summer but this has me concerned. None of my other doctors have said this could delay the process. I'm doing this surgery hopefully to reverse my diabetes or at least get me off some of my meds. What are you eating, start reducing your sugars and drabs remember everything you eat turns into sugar, replace at least 1 meal with a Protein Drink you will see a huge difference in a month. I agree cut down your carbs and sugar intake. Stay away from juices very high in natural sugars. If you eat yogurt get plain and add your own sweetener to it and a little fruit. Protein shakes are great but read the label for ingredients and make sure there is not sugar in it. If you are going to make your own shakes then I recommend Jay Robb whey Protein powder made with stevia. It comes in vanilla , strawberry and chocolate . You can find it at a Whole foods, Amazon , eBay or directly from the company. If you want some flavors added to it I recommend Toscani sugar free syrups made with Splenda. You can find them at World Market, Amazon, eBay or directly for Toscani. These are just a few suggestions of what I would do. I had diabetes and was on 2 types of diabetes medicine prior to surgery. During the 6 month medically monitored weight loss program mandated by my insurance company, I lost 20 pounds. As a result I Continue reading >>

5 Simple Ways To Lower Your A1c This Week

5 Simple Ways To Lower Your A1c This Week

The A1C blood test is a simple test that analyzes your glucose (blood sugar) levels by measuring the amount of glycated hemoglobin in your blood. Hemoglobin is a protein in your red blood cells; when glucose enters the blood, it attaches to the hemoglobin. The result is glycated hemoglobin. The more glucose in your blood, the higher your glycated hemoglobin. The A1C is a valuable indicator of how well your diabetes management plan is working. While your individual A1C goal will depend on factors including your age and your personal medical profile, most people with diabetes aim to keep their A1C below 7 percent. By keeping your A1C number within your target range, you can reduce the risk of diabetes complications. While it is important to develop a long-term diabetes management plan with your physician, there are several steps you can take right away to help reduce your A1C. Small changes add up, so consider trying some of these strategies to lower your A1C this week. 1. Try Short Sessions of High Intensity Exercise According to research presented at the American Heart Association's Scientific Sessions 2015, type 2 diabetes patients who did 10 minutes of exercise three times a day, five days a week at 85 percent of their target heart rate had a twofold improvement in A1C levels compared to patients who exercised for 30 minutes a day at 65 percent of their target heart rate. Be sure to check with your doctor before trying high intensity exercise, and wear a heart rate monitor so you don’t overdo it. 2. Shrink Your Dinner Plate Instead of a large dinner plate for your meals, use a smaller salad plate. This simple swap can trick your eyes and brain into thinking you’re eating more than you really are, and you’ll feel satisfied with less food. It’s especially helpfu Continue reading >>

Surgery Doesn’t Have To Be An Ordeal For People With Diabetes

Surgery Doesn’t Have To Be An Ordeal For People With Diabetes

North Carolina-based Marc S. Stevens, MD, FACS, is one of the top orthopedic surgeons in the country. Previously, while practicing in Little Rock, he was named Arkansas Physician of the Year. In addition to his orthopedic expertise, Dr. Stevens has developed a reputation as an expert in nutrition, especially as it relates to wound healing, bone and joint health, and healthy weight. To learn more about Dr. Marc S. Stevens go to www.DRSHealthInc.com When Dr. Stevens spoke recently with Diabetes Health Publisher and Editor-in-Chief Nadia Al-Samarrie, he provided a surgeon’s point of view about surgery for people with diabetes. Nadia: Your focus on nutrition is wonderful-and unusual. Why are you so interested in nutrition? Dr. Stevens: You have to go back to the 1980s, when proponents started to claim that good nutrition could do anything: “It will grow your hair back, it will make you taller, it will make you stronger, it will make you 18 again.” Instead of getting involved and trying to redirect those outlandish claims in a more scientific direction, medicine kind of stepped back and said, “Well, we’re not going to have anything to do with nutrition anymore. We’re just going to go what’s called the allopathic route and focus on what we do best.” As a result, we lost a chance to connect with an important aspect of health. Most doctors still grasp that nutrition is vital. The reason we call certain things “vitamins” is because they are vital minerals, essential to good health. We all check for them, and we treat deficiencies when we find them lacking. But when it comes to prevention and how nutrition can support wound recovery or preparation for surgery, we just don’t typically think that way. Because I have paid close attention to nutrition, I’ve be Continue reading >>

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